shoulder pain

More about how the shoulder blade works with the shoulder and how bad shoulder girdle strength can cause shoulder impingement. The image and movie clip below show shoulder blade elevation, with the actress in the video showing LESS elevation and upward rotation on the left than the right.

The space between the ball (humeral head) and the shelf above (acromium) which sits on the shoulder blade is where impingement of one or two of the rotator cuff tendons happens (supraspinatus or infrapinatus).
Here is an image of a normal shoulder and one with impingement:

normal shoulder anatomy

shoulder pain caused by impingement

If the shoulder blade is hanging low (like the one on the left in the video) the space for the tendon is a lot smaller. So doing shoulder blade strengthening exercises to elevate the shoulder blades will help with shoulder blade pain itself.

I have been vacationing this past week on San Juan island on the west side of the island. My husband I went out kayaking (on a guided tour, thank goodness) and had a great time. We saw harbor seals, a giant jelly fish and beautiful scenery.

While we were kayaking, I noticed the movements could have caused me some shoulder pain, but I used positions which kept my upper arms down lower than shoulder height, and avoided a rotator cuff strain or impingement.

As you can see, shoulder impingment and bursitis can be caused when the arm is at or above shoulder height by jamming the ball of the shoulder up into the acromium.

The correct arm stroke is to keep the elbow a few inches below the shoulder, and push forward with the elbow while pullling back the the other arm. Use your oblique abdominals to help power your stroke to keep the strain off the shoulder, too. Here's a video from Youtube about proper kayak technique

Have you ever wondered if you should have an MRI? Did your health care provider tell you that you did not need one and you wondered why not?

I had a patient from Lacey with a shoulder bursitis ask me that question…and I told her "no" I didn't think she needed an MRI. She had come to me with horrible shoulder pain; on her first visit we simply treated her bad pain after performing a few safety tests to make sure these procedures were safe. On her first visit she could only lift her arm 3 inches, had to be driven to PT and had to have help getting dressed.

After a 3 or 4 visits, she had a lot less pain. She could drive herself, get dressed and lift her arm overhead. She still had pain rotating her lower arm out to the side and had some tingling and numbness. I evaluated her and told her I thought she had had a bursitis and possibly an infraspinatus (one of the 4 rotator cuff muscles) strain but not tear. She wanted to know if she should have an MRI, and I told her I did not think so….she wanted to know why not.

I walked her through the process of understanding how a physical therapist sees if a muscle is torn. I took a large theraband, and showed her how a torn or cut muscle cannot bring the two ends of the joint together if it is not attached in the middle. A physical therapist knows what directions a specific muscle moves the joint. Seeing a joint move the in direction of the muscle tells the physical therapist that the muscles is not torn; if it was torn the joint would not move. Once she had that explanation she understood why she did not need an MRI.

If you want to know why you don't need an MRI, take the time to ask your provider why not…so you can understand the process.

Is your arm or pushup P90X workout difficult? Did you order your P90X to come to Olympia, Lacey or Tumwater, only to find out you are having problems? Are you struggling but not sure why? Do you have shoulder blade or middle back pain? You might have weak shoulder blade muscles that make your shoulder wobbly on your ribs. Here is what this looks like (the left side is the weak side) when you lift your arms up overhead :